Geneva –Fewer newborns are dying worldwide, but progress is too slow and Africa particularly is being left further behind. These are the findings of a new study published in the medical journal PLoS Medicine today. The study covering 20 years and all 193 WHO Member States was led by researchers from WHO, Save the Children and the London School of Hygiene and Tropical Medicine. The estimates are based on more data than ever and extensive consultations with countries. The study shows detailed trends over time and forecasts potential future progress.

Newborn deaths decreased from 4.6 million in 1990 to 3.3 million in 2009, but fell slightly faster since 2000. More investment into health care for women and children in the last decade when the United Nations Millennium Development Goals (MDGs) were set, contributed to more rapid progress for the survival of mothers (2.3% per year) and children under the age of five (2.1% per year) than for newborns (1.7% per year).

According to the new figures, newborn deaths, that is deaths in the first four weeks of life (neonatal period), today account for 41% of all child deaths before the age of five. That share grew from 37% in 1990, and is likely to increase further. The first week of life is the riskiest week for newborns, and yet many countries are only just beginning postnatal care programmes to reach mothers and babies at this critical time.

Causes of neonatal deaths: preterm delivery, asphyxia and infections

Three causes account for three quarters of neonatal deaths in the world: preterm delivery (29%), asphyxia (23%) and severe infections, such as sepsis and pneumonia (25%). Existing interventions can prevent two-thirds or more of these deaths if they reach those in need.

“Newborn survival is being left behind despite well-documented, cost-effective solutions to prevent these deaths,” says Dr. Flavia Bustreo, WHO Assistant Director-General for Family, Women’s and Children’s Health. “With four years to achieve the Millennium Development Goals, more attention and action for newborns is critical.”

Where babies are born dramatically influences their chances of survival

Almost 99% of newborn deaths occur in the developing world. The new study found that in part because of their large populations, more than half of these deaths now happen in just five large countries – India, Nigeria, Pakistan, China and Democratic Republic of the Congo. India alone has more than 900,000 newborn deaths per year, nearly 28% of the global total. Nigeria, the world’s seventh most populous country, now ranks second in newborn deaths up from fifth in 1990. This is due to an increase in the total number of births while the risk of newborn death has decreased only slightly. In contrast, because the number of births went down and the risk of newborn death was cut in half (23 to 11 per 1000), China moved from second place to fourth place.

With a reduction of 1% per year, Africa has seen the slowest progress of any region in the world. Among the 15 countries with more than 39 neonatal deaths per 1000 live births, 12 were from the WHO African Region (Angola, Burundi, Chad, Central African Republic, Democratic Republic of the Congo, Equatorial Guinea, Guinea, Guinea-Bissau, Mali, Mauritania, Mozambique, and Sierra Leone) plus Afghanistan, Pakistan and Somalia. At the current rate of progress it would take the African continent more than 150 years to reach U.S. or U.K. newborn survival levels.

Of the ten countries with a newborn mortality reduction of more than two-thirds in these two decades, eight were high income countries (Cyprus, Czech Republic, Estonia, Greece, Luxembourg, Oman, San Marino and Singapore), and two were middle income countries (Maldives and Serbia).

“This study shows in stark terms that where babies are born dramatically influences their chances of survival, and that especially in Africa far too many mothers experience the heartbreak of losing their baby,” said co-author Dr. Joy Lawn of Save the Children’s Saving Newborn Lives program. “Millions of babies should not be dying when there are proven, cost-effective interventions to prevent the leading causes of newborn death.”

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